MEDICARE: MICHELLE LOUISE GREISSINGER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN011694	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN011694	OTHER	GA	DENTAL LICENSE NO.

General Provider Information

NPI Number	:	1780780122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LOUISE GREISSINGER DMD

Provider Business Mailing Address
First Line	:	1512 PIEDMONT AVE NE
Second Line	:	SUITE 202
City	:	ATLANTA
State	:	GA
Zip	:	30324-5044
Country	:	US
Telephone Number	:	404-873-2957
Fax Number	:	404-873-2526

Provider Business Practice Location Address
First Line	:	1512 PIEDMONT AVE NE
Second Line	:	SUITE 202
City	:	ATLANTA
State	:	GA
Zip	:	30324-5044
Country	:	US
Telephone Number	:	404-873-2957
Fax Number	:	404-873-2526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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